Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis

Bedaso, Asres; Mekonnen, Nibretie; Duko, Bereket

doi:10.1136/bmjopen-2021-058187

Cited by 37 publications

(27 citation statements)

References 61 publications

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“…The prevalence of anxiety in our study is in accordance with previous assessments using alternative questionnaires such as APAIS 15,16 , APAIS-A-T 4 or STAI-scores 17,18 . Still, many systematic reviews and meta-analysis do not differentiate surgical-related from directly anaesthesia-related anxiety, resulting in a far range of 20-80% in reported prevalence of perioperative anxiety in current literature 19,20 . Recent evidence supports our claim of separating these two types of anxiety, as anxiety related to surgery remains higher compared to directly anaesthesia-related anxiety 21 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of patient-reported perioperative anaesthesia-related anxiety, anxiety triggers and its association with patient satisfaction: a retrospective, observational study in Switzerland

Bello

Nuebling²,

Koster

et al. 2023

Preprint

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Perioperative anxiety is a widespread complaint. The mutual relation between anxiety and patient satisfaction with anaesthesia is still under debate. We assessed the prevalence and different triggers of perioperative anxiety and the association with patient satisfaction. A psychometric questionnaire1 was sent to patients after discharge. Clinical Data was used from a previous study. Statistical analysis included bivariate and multivariate regression models. 141 patients (30%) reported anxiety regarding anaesthesia before admission to hospital. The prevalence of anxiety was significantly associated with patient age < 54 years (n = 196, prevalence = 37%, p = 0.002), female gender (n = 242, prevalence 39%, p < 0.001) and surgical specialty (gynaecology (n = 61, prevalence = 49%), otolaryngology (n = 56, prevalence = 46%) p < 0.001). The fear of not waking up from anaesthesia (n = 44, prevalence 32%, SD 45.8) and of developing postoperative nausea or vomiting (n = 42, prevalence 30%, SD 46.0) were the most reported triggers of anxiety. The presence of anxiety was associated with impaired overall patient satisfaction (mean dissatisfaction score 23%, SD 16.3, p < 0.001), especially regarding the dimensions “information and involvement in decision-making” (14% of deficits stated in non-anxious group compared to 23% in anxious group, p < 0.001), “respect and trust” (2% vs 6.26%, p < 0.001) and “continuity of care” (50% vs 57%, p < 0.015).

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Section: Discussionmentioning

confidence: 99%

Prevalence of patient-reported perioperative anaesthesia-related anxiety, anxiety triggers and its association with patient satisfaction: a retrospective, observational study in Switzerland

Bello

Nuebling²,

Koster

et al. 2023

Preprint

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“…Despite various perioperative interventions, some patients proceed with surgery because of signi cant anxiety. However, no research has been done on the characteristics of patients who are anxious due to a non-response to perioperative interventions [8,9,10]. By analyzing the characteristics of patients who do not respond to interventions such as preoperative rehabilitation or education, it may be possible to select patients who require a higher level of intervention, such as consulting a psychiatrist or taking anti-anxiety medications [11,12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Preoperative severe pain, decreased function, and high anxiety levels increase preoperative anxiety in patients who underwent primary total knee arthroplasty

Park,

Jeon,

Kim

et al. 2024

Preprint

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Patients experience clinically significant anxiety from the time they are recommended to undergo total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of a preoperative intervention regarding anxiety levels in patients undergoing TKA for knee osteoarthritis (OA) and to evaluate whether patient characteristics affect the effectiveness of the intervention according to anxiety level. This retrospective observational study recruited 89 patients who underwent TKA under general anesthesia for knee OA. The preoperative intervention comprised rehabilitation education and an interview with an orthopedic surgeon regarding surgical preparation status. The State-Trait Anxiety Inventory (STAI) was administered before and after the preoperative intervention. The mean STAI score significantly improved after the intervention. The proportion of patients with clinically meaningful state anxiety (CMSA) also significantly decreased after the intervention. There were no significant differences in demographic and social factors between the two groups. However, the patients whose CMSA status did not improve experienced severe pain, poor functional scores, and high anxiety scores. For patients undergoing TKA, the implementation of a patient-specific intervention, which consists of preoperative rehabilitation education and a surgeon interview, helps reduce preoperative anxiety. However, these interventions may not be effective in patients who present with severe pain, poor functional status, or high anxiety levels before surgery. Thus, higher levels of intervention for anxiety may be necessary.

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“…a surgical procedure), it is important to distinguish this type of anxiety with trait anxiety, which can be defined as an anxious personality [14]. It is reported that 48 to 56% of patients admitted for surgery experience preoperative anxiety, and even reaches 85% in day surgery patients, which may cause hemodynamic change during anesthetic induction as well as increase the requirement of anesthetics introperatively, leading to an increased risk of postoperative complications [15][16][17][18][19][20][21]. Given the high prevalence of preoperative anxiety, abundant protocols to reduce anxiety have been administrated before surgery including pharmacological therapy and non-pharmacological therapy.…”

Section: Introductionmentioning

confidence: 99%

Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis

Yang

Detroyer²,

Grootven³

et al. 2023

BMC Geriatr

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Background Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to explore the association between preoperative anxiety and POD in older surgical patients. Methods Electronic databases including MEDLINE (via PubMed), EMBASE (via Embase.com), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete; via EBSCOhost) and clinical trial registries were systematically searched to identify prospective studies examining preoperative anxiety as a risk factor for POD in older surgical patients. We used Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies to assess the quality of included studies. The association between preoperative anxiety and POD was summarized with odds ratios (ORs) and 95% confidence intervals (CIs) using DerSimonian-Laird random-effects meta-analysis. Results Eleven studies were included (1691 participants; mean age ranging between 63.1–82.3 years). Five studies used a theoretical definition for preoperative anxiety, with the Anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A) as the instrument being most often used. When using dichotomized measures and within the HADS-A subgroup analysis, preoperative anxiety was significantly associated with POD (OR = 2.17, 95%CI: 1.01–4.68, I2 = 54%, Tau2 = 0.4, n = 5; OR = 3.23, 95%CI: 1.70–6.13, I2 = 0, Tau2 = 0, n = 4; respectively). No association was observed when using continuous measurements (OR = 0.99, 95%CI: 0.93–1.05, I2 = 0, Tau2 = 0, n = 4), nor in the subgroup analysis of STAI-6 (six-item version of state scale of Spielberger State-Trait Anxiety Inventory, OR = 1.07, 95%CI: 0.93–1.24, I2 = 0, Tau2 = 0, n = 2). We found the overall quality of included studies to be moderate to good. Conclusions An unclear association between preoperative anxiety and POD in older surgical patients was found in our study. Given the ambiguity in conceptualization and measurement instruments used for preoperative anxiety, more research is warranted in which a greater emphasis should be placed on how preoperative anxiety is operationalized and measured.

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Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis

Cited by 37 publications

References 61 publications

Prevalence of patient-reported perioperative anaesthesia-related anxiety, anxiety triggers and its association with patient satisfaction: a retrospective, observational study in Switzerland

Prevalence of patient-reported perioperative anaesthesia-related anxiety, anxiety triggers and its association with patient satisfaction: a retrospective, observational study in Switzerland

Preoperative severe pain, decreased function, and high anxiety levels increase preoperative anxiety in patients who underwent primary total knee arthroplasty

Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis

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